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General NPI Number Information
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NPI Number | 1649569450
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Entity Type | Organization
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Legal Business Name | ANDERSEN EYE PROSTHETICS LLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 5161 CARDINAL PARK DR
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City | SAGINAW
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State | MI
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Zip | 48604
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Country | US
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Telephone | 989-249-8853
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Fax | 989-249-8842
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Provider Business Mailing Address
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Address Line | PO BOX 5649
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City | SAGINAW
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State | MI
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Zip | 48603-0649
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Country | US
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Telephone | 989-249-8853
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Fax | 989-249-8842
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Authorized Official
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Title or Position | CEO
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Name | ALICIA OCONNOR
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Credential |
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Telephone | 989-341-7170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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